Avg time with patients

[IMres85]

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Just curious what everyone’s average time with patient is. Im trying to get better about spending more time with patients as I generally have everything squared away and a plan before entering the room.

Just curious for specifically - new hemes (simple IDA), new onc, follow up benign simple hemes, and follow up onc visits (assuming no profession/change in treatment )

 

[gutonc]

Just curious what everyone’s average time with patient is. Im trying to get better about spending more time with patients as I generally have everything squared away and a plan before entering the room.

Just curious for specifically - new hemes (simple IDA), new onc, follow up benign simple hemes, and follow up onc visits (assuming no profession/change in treatment )

Like time in the room or schedule time for the visit?

Room time: 10 min tops for pretty much anything that's not a change in treatment or EOL stuff for a follow up. 20 min for new hemes. 30-40 for new onc depending on how complete the workup was and how competent the referring doc is.

Schedule time: 20 for follow ups, 40 for new hemes and transfers of care, 60 for new oncs

Actual time spent on the case: 11-120 minutes.

 

[MD46]

It varies and each patient is different, on the first visit I can gauge who wants more time and who wants less. I use the sticky note feature in EPIC to make notes for myself for future visits.

New Onc patients, i always have 45mins , New heme 20-30mins, followups 10-15 mins. Some take less some more, so through out the day, times pretty much avg out.

Some of the heme patients with fibromyalgia, POTS, EDS spectrum issues have many other things to talk about so some times even if its not relevant I listen and spend more time.

 

[gutonc]

Some of the heme patients with fibromyalgia, POTS, EDS spectrum issues have many other things to talk about so some times even if its not relevant I listen and spend more time.

Hard pass on that bulls***. Whatever naturopath or (dys)functional medicine charlatan that convinced them they had that made up nonsense can deal with that. If they decide that they don't want to come back to see me because I "wasn't listening", bullet dodged.

 

[osprey099]

New and follow up heme: 15 min appt. Spent 5 mins with patient

New Onc: 30 min appt. Spent 20-30 mins with patient

Follow up Onc: 15 min appt. Spent 10-15 mins with patient

 

[bobsmith]

Im trying to get better about spending more time with patients

But what's your goal here?

Are you trying to slow down so that your life is more sustainable, are you trying to build more rapport with pts, not be seen as a rushing doctor, etc?

 

[HemeOncHopeful19]

Some of the heme patients with fibromyalgia, POTS, EDS spectrum issues have many other things to talk about so some times even if its not relevant I listen and spend more time.

I usually end up getting fired by those patients (although not intentionally) - just noticed GutOnc seems to employ the same strategy and now I feel a lot better about it.

 

[gutonc]

I usually end up getting fired by those patients (although not intentionally) - just noticed GutOnc seems to employ the same strategy and now I feel a lot better about it.

I don't try to get fired. But I set boundaries.

"Dr. Witchdoctor, BSN, LAc, ND sent you to me for your MCV of 100.2 with an otherwise completely normal CBC. I'm going to do the $5000 lab workup and maybe even a bone marrow, just to make sure I get my pound of flesh since you're happy paying that idiot $1000 a month cash for IV vitamin C, and once I confirm what I knew going in, that there's nothing wrong with you, I'm going to discharge you from clinic...and if you'd like to leave before all that gets done, that's cool too."

 

[IMres85]

New and follow up heme: 15 min appt. Spent 5 mins with patient

New Onc: 30 min appt. Spent 20-30 mins with patient

Follow up Onc: 15 min appt. Spent 10-15 mins with patient

This is exactly how I do it really. Some of these new hemes literally take 5 minutes and I almost feel guilty they’re so quick but really I can ask enough history in that time. I probably should get better about just giving a few minutes for chit chat but my schedule can be so busy - average 28-30 patients k schedule - generally 24 show and there’s generally 6-7 new hemes and 2-4 new oncs

 

[IMres85]

But what's your goal here?

Are you trying to slow down so that your life is more sustainable, are you trying to build more rapport with pts, not be seen as a rushing doctor, etc?

The latter.

 

[HemeOncHopeful19]

I don’t think there is a solid way to schedule 30pt a day and not come off as a “rushing doctor”… you are one!

 

[gutonc]

I don’t think there is a solid way to schedule 30pt a day and not come off as a “rushing doctor”… you are one!

100%. Unless you're working 12h days, you just don't have enough time to build that rapport. That's just fine for some physicians (and some patients), but if that's not what you want, you need to make changes.

ETA: And I don't mean you need to increase your clinic efficiency. I mean you need to see fewer patients or extend your clinic day. If neither of those are options for you, you're stuck with what you've got for now.

 

[Ubba]

My time mgmt is not as good as the posts above from the more-experienced docs, but my strategy is to avoid open-ended Qs at all costs.

Come in, start by telling pt "Here's what I know so far, tell me if anything is wrong", rattle off all the info you got beforehand that's relevant (CTs, abnormal labs, symptoms, etc.), and by the time you're doe (~3-5 min), the pt pretty much won't have anything to add. Ask a few pointed ROS Qs, do an exam (can even do these concurrently) and give them the outline of the workup you'll perform. Less time spent and the pt doesn't mind because he/she sees that you did your homework beforehand.

 

[IMres85]

My time mgmt is not as good as the posts above from the more-experienced docs, but my strategy is to avoid open-ended Qs at all costs.

Come in, start by telling pt "Here's what I know so far, tell me if anything is wrong", rattle off all the info you got beforehand that's relevant (CTs, abnormal labs, symptoms, etc.), and by the time you're doe (~3-5 min), the pt pretty much won't have anything to add. Ask a few pointed ROS Qs, do an exam (can even do these concurrently) and give them the outline of the workup you'll perform. Less time spent and the pt doesn't mind because he/she sees that you did your homework beforehand.

That’s exactly what I do as well. I’m finding I’m having issues remembering patients unless I find something about them personally however. I work in an area im from and it’s not hard to make connections with knowing similar people, then I’m more apt to remember them - which just makes a substantial difference. Particularly because with our fleet of APPs sometimes I can easily go 4-6 months without seeing a patient on treatment (assuming things are going smoothly). Personality I need about 4-6 interactions with a patient to remember them (probably additional meetings if I am to remember name)

 

[HemeOncHopeful19]

Particularly because with our fleet of APPs sometimes I can easily go 4-6 months without seeing a patient on treatment

I think I found your problem

 

[checkpointinhibitor]

Particularly because with our fleet of APPs sometimes I can easily go 4-6 months without seeing a patient on treatment (assuming things are going smoothly). Personality I need about 4-6 interactions with a patient to remember them (probably additional meetings if I am to remember name)

This ! is the problem. We do not have APPs and all patients are seen by MDs. Most of my colleagues know their patients really well due to this, including myself. Wake me up at night and I can you a clinically relevant history on more than 70-80% of my patient panel. This cuts our visit times much shorter and IMO, good for patients long term.

Again an example where admin overlords make you think that APPs are there to 'help' you. IMO, anything but.

 

[bobsmith]

This ! is the problem. We do not have APPs and all patients are seen by MDs. Most of my colleagues know their patients really well due to this, including myself. This cuts our visit times much shorter and IMO, good for patients long term.

Again an example where admin overlords make you think that APPs are there to 'help' you. IMO, anything but.

As someone who also sees pretty much all of my patients all of the time, I agree that this is definitely the way to do things if you can.

From an admin standpoint, what you've described is terrible: if you have shorter appointment times -> you could see more patients -> you get more productivity -> they have to pay you more

You don't really need an MBA to realize, "Hey, it sure would be nice if we could take some of that productivity away from 'Dr. 90th Percentile wRVU' and pay an APP a cheaper salary to do so," especially if it doesn't change the infusion revenue at all

There's also the long-term benefit / career sustainability of having your schedule filled with a mixture of stable disease / happy patients on a daily basis, instead of only seeing patients who are progressing, having toxicity from treatment, and/or have saved up their 4-6 months worth of questions for you

 

[HemeOncHopeful19]

As someone who also sees pretty much all of my patients all of the time, I agree that this is definitely the way to do things if you can.

From an admin standpoint, what you've described is terrible: if you have shorter appointment times -> you could see more patients -> you get more productivity -> they have to pay you more

You don't really need an MBA to realize, "Hey, it sure would be nice if we could take some of that productivity away from 'Dr. 90th Percentile wRVU' and pay an APP a cheaper salary to do so," especially if it doesn't change the infusion revenue at all

There's also the long-term benefit / career sustainability of having your schedule filled with a mixture of stable disease / happy patients on a daily basis, instead of only seeing patients who are progressing, having toxicity from treatment, and/or have saved up their 4-6 months worth of questions for you

Admin will only see your new patient volume (I'm sure there are good Admin out there but for purposes of this discussion)

"Each X cancer patient we treat represents Y revenue, who cares if they follow up with a midlevel or the doctor. Keep the MDs seeing new patients as much as possible to keep the spice chemo flowing."

 

[dozitgetchahi]

I don't try to get fired. But I set boundaries.

"Dr. Witchdoctor, BSN, LAc, ND sent you to me for your MCV of 100.2 with an otherwise completely normal CBC. I'm going to do the $5000 lab workup and maybe even a bone marrow, just to make sure I get my pound of flesh since you're happy paying that idiot $1000 a month cash for IV vitamin C, and once I confirm what I knew going in, that there's nothing wrong with you, I'm going to discharge you from clinic...and if you'd like to leave before all that gets done, that's cool too."

Out here in Rheumatology Land, that’s usually how these consults go also…except that it’s usually a positive ANA. I’ve reached the point where I more or less actively encourage the patient to move on.

 

[gutonc]

Out here in Rheumatology Land, that’s usually how these consults go also…except that it’s usually a positive ANA. I’ve reached the point where I more or less actively encourage the patient to move on.

Extract your pound of flesh and be done.